The strange human disinterest in cardiovascular disease and the efforts the World Health Organization is making to confront it.
By Karin Pollack
The digital age shows quite impressively how the human psyche is contradictory sometimes. What about the estimation of dangers to life? This is what scientists at the University of California in San Diego wanted to know, and in order to answer this question they obtained data from the Google search engine on their users' health-related questions. On the other hand, the content of US online portals was evaluated between 1999 and 2016. As a counterpoint, they compared the death statistics of the Center for Disease Control and Prevention (CDC), which determine which diseases actually kill US citizens.
The result: the most searched terms on Google were "fear of murder" and "fear of terrorism". Statistically, the number of people dying from it is extremely small. However, what is really life-threatening for people in the 21st century are cardiovascular diseases and cancer. Therefore, when real dangers like heart attacks or strokes occur, the human psyche seems to deal with these risk factors unimpressed, at least the interest in it appears low.
This is precisely one of the problems with which those responsible see themselves increasingly confronted with in various health fields. Cardiovascular diseases are dangerous killers; they are diseases that cause a lot of suffering and impair the quality of life. However more important is the fact that some of them could actually be avoided. Among other things, the unhealthy lifestyle is contributing massively to the rising number of ill people. That is why they are also referred to as "lifestyle diseases". Unhealthy diets, lack of exercise, smoking and alcohol are the silent killers of the 21st century. "There are hundreds of other risk factors that influence and multiply each other," says Thomas Dorner of the Centre for Public Health at the Medical University of Vienna, stressing that social factors are more and more becoming the focus of public health research. Data show that education, loneliness or the workplace situation are all factors to be calculated into the risk formula.
„The disease stroke has become increasingly an illness affecting people who are still in their working process.“
Causes almost a third of all fatalities
In 2016, 17.9 million people worldwide died of cardiovascular diseases, which is 31 percent of all causes of death. The World Health Organization (WHO) has called for this situation and that a change in lifestyle could push down this figure massively. As early as 2013, those responsible were considering measures to raise public awareness of this problem. The situation appears to be extremely difficult. Many organ systems in the human body interlock. Cardiovascular diseases have different causes. For example, overly high blood pressure or cholesterol levels or arteriosclerosis plays a role. Nevertheless, there are also many other modern ailments that burden the cardiovascular system. Diabetes, or respiratory diseases such as COPD, have an effect on the entire system. "The income situation of a household also has an impact," emphasizes public health expert Dorner. Above all, the increasing number of obese patients is a major concern for those involved because the high number of bodily fat cells leads to a particularly negative effect on the cardiovascular system, even in children.
The new naming - NCDs
In any case, the WHO considered it essential to give this group of different diseases a new name calling them noncommunicable diseases (NCDs) in order to define illnesses, which are not directly transmitted from person to person, unlike infections. Although the very risk of infection might alarm people, this is not the case with NCDs. Often the unspectacular and slow-paced diseases with their symptoms, whose damage and ultimately destruction of the organism happens gradually, are accepted by the majority of people as inevitable.
Noncommunicable diseases (including cancer) account for 86 percent of deaths in Europe and 77 percent of all diseases. In Austria, they even lead the statistics on diseases. They are also the cause of premature death, concerning those under the age of 70. In most cases, it is heart attacks or strokes resulting from cardiovascular diseases that suddenly rip people out of their lives. In 2015, statistics recorded around 17 million such premature deaths worldwide. "Strokes are increasingly becoming a disease of people who are still at work," says Valery Feigin, a New Zealand-based WHO consultant. In view of these facts, the World Health Organization adopted the "Global Action Plan for the Prevention and Control of NCDs 2013 to 2020" (Resolution WHA66.10) in 2013, which is a roadmap of measures to provide guidance for policymakers. The goal is to reduce the number of premature deaths from cardiovascular diseases by 25 percent until 2025. Dorner is convinced that disease prevention always needs two pillars as basis. The first is to promote health literacy at the individual level; the technical term for this is health literacy. Meaning: regular check-ups, self-responsible lifestyles and living voluntarily a healthy lifestyle based on the individual conviction that the direct benefit for one's own person draws therefrom.
On the other hand, according to Dorner, society must also set health-promoting course and push back things proven harmful. He cites smoking bans as a current example. These two pillars must under no circumstances be played off against each other," says Dorner, "the best effects are achieved with both together.
„When talking about cardiovascular diseases, nobody considers the role of the consumer goods industry in the global financial market.“
The marks industrialization left
Cardiovascular diseases are not individual strokes of fate that affect one or the other person on this planet. On the contrary: the massive increase in cardiovascular diseases is the result of many different causes in various life areas, which, after 120 years of industrialization, manifest itself as a disease amongst a large number of people. "Cardiovascular diseases cannot be regarded as self-inflicted, they are a consequence of industrialization," says Ilona Kickbusch, who works for the WHO in the Commission for Non-Communicable Diseases. The industry also makes people ill, she says. For example, the food industry, whose products consumers are unconsciously confronted with every day in the supermarket. Where is the connection? Food offered in supermarkets has to be preserved. Sugar and salt are popular ways of doing this. That's why ready meals also damage the cardiovascular system. Cardiovascular diseases are the leading "industrial epidemics" in this understanding, i.e. diseases caused by people's changing lifestyles.
The problem western lifestyle
The life expectancy of US American men has been reduced by 3 years since 2014.
Western lifestyle and its consequences
Over the last few years, the WHO has also observed that cardiovascular diseases always rise significantly when the so-called "western lifestyle" arrives in a country. Therefore, the WHO introduced the concept "commercial determinants for health" as a new technical term four years ago. According to Kickbusch, the big problem is that rational arguments simply cannot counter the large food companies' massive advertising campaigns. "Emotional messages spread lies," she says.
"Industrial epidemics are diseases caused by profit," the WHO says in a groundbreaking article in the medical journal The Lancet. Proof of this thesis lies in the first decline of life expectancy in the world's most industrialized country. In this year’s spring, the WHO published a report according to which the life expectancy of Americans declined for the first time in many decades. Today, men in the USA live to be 76 years on average, compared to 79 years of age recorded in 2014. "Obesity is one of the causes," says WHO data specialist Samira Asma.
However, the "American lifestyle" is also toxic to health overall. In hardly any other country, people are more dependent on their car in means of transport, resulting in a lack of exercise, a determinant of NCDs, as well as air pollution. "The greater the concentration of fine dust in the air we breathe, the more likely cardiovascular diseases come to be," says Thomas Meinertz, Chief Cardiologist at the German Heart Foundation. When inhaled, fine dust enters the pulmonary epithelium and thus the blood. As a foreign body, it triggers an immune reaction in the vascular system in the form of chronic inflammation, which in turn triggers arteriosclerosis - a cause of heart attack and stroke. Therefore, according to Meinertz, a sustainable traffic turn or the withdrawal from energy production through coal is a healthy measure in the sense of containing cardiovascular diseases.
The heart and its circulation
The heart is the pump that pumps the blood through all the vessels of the body. Cardiovascular diseases are disturbances in this exceedingly adaptable, constantly changing system that adapts to efforts as well as in relaxation, in order to be able to supply the organs with blood and thus oxygen and nutrients. Cardiovascular diseases originate from the vascular system and/or the heart and are mostly caused by age-related arteriosclerosis. Due to age, the walls of the blood vessels become more brittle and stiff, and there they can then accumulate fat deposits. If they come loose and block the heart, brain or lungs, it can lead to death. In this respect, cardiovascular diseases are an umbrella term for a number of disorders. In coronary heart disease, the blood vessels around the heart are no longer intact, they can no longer supply the heart muscle and a heart attack is likely the results. But it can also affect the blood vessels leading to the brain, which might lead to a stroke. It is also possible that the blood vessels leading to the arms and legs are diseased, which manifests itself as peripheral arterial occlusive disease. Embolisms or thromboses in the veins of the body also have a massive impact on the cardiovascular system and can be life-threatening.
„Apart from unhealthy diets, smoking and alcohol, there are hundreds of other risk factors that reciprocally potentialize the impact.“
Role of the consumer goods industry
However, Ilona Kickbusch sees the connections in an even broader context. "Nobody thinks about the role of the consumer goods industry on the global financial market," she says, certainly politicians do not. Many large corporations are listed on international stock exchanges. The fact that profit maximization strategies make people ill is an interdependence of which very few people are aware. Taxes, for example on sugar or meat, are being discussed as possible measures to steer the market in healthier directions - politically mostly less popular and therefore less promising measures.
Speaking of politics. "We have indications that the tobacco industry is also making a lot of money on the global financial market with high-return shares," she says, and interestingly enough primarily right-wing parties block non-smoking laws and are supported by the tobacco industry.
NCDs weaken the economy
In macroeconomic terms, noncommunicable diseases weaken economies in the long term. Carry Adams, Chairman of the NCD Alliance, calculates that "it could lead to annual losses of up to four percent in countries' gross domestic product". Since NCDs are very expensive, people with cardiovascular disease, obesity or diabetes usually have to be treated for many years. Therefore, WHO consultant Valery Feigin underlines the importance of global awareness campaigns such as the one the World Stroke Organization will launch in presenting the "Stroke Riskometer App" in 15 languages on 28 October (see also interview with Michael Brainin). It calculates the individual probability of suffering a stroke in the next five to ten years, warns of check-ups for blood pressure and cholesterol and gives lifestyle tips to reduce the risk. "We assume that this will enable us to significantly reduce the number of strokes," says Feigin.
However, the biggest obstacle will probably remain. The fact that cardiovascular diseases do not cause pain before a stroke or heart attack occurs and therefore will always elude human attention. It would be the responsible politicians' task to take measures to promote health from a holistic perspective and to check laws in all areas of society for their suitability for health and to take countermeasures if necessary. That would be a truly ambitious goal.
Karin Pollack heads the health section of the Austrian daily newspaper "Der Standard"
Dr. Valery Feigin is Professor of Epidemiology and Neurology. He is the Director of the National Institute for Stroke and Applied Neurosciences in New Zealand. Feigin is also an advisor to the World Health Organization (WHO) in the field of stroke and worked on the WHO classification of diseases ICD-11.
Dr. Ilona Kickbusch studied political science at the University of Konstanz. She is currently an associate professor at the Graduate Institute of International and Development Studies in Geneva, Switzerland. Kickbusch headed the Global Health Promotion Programmes of the WHO.
The cardiologist and pharmacologist Prof. Dr. Thomas Meinertz is chief cardiologist at the German Heart Foundation, of which he was previously chairperson. He studied human medicine at the universities of Mainz and Innsbruck. He heads the cardiology department of the University Medical Center Hamburg-Eppendorf.
Assoc. Prof. PD Dr. Thomas E. Dorner, MPH, is President of the Austrian Society for Public Health and Deputy Head of the Department of Social and Preventive Medicine at the Center for Public Health of the Medical University of Vienna.
More articles in this issue (in German)